Substance Exposed Newborns | Harm Reduction - Please Read

Length of Stay

96 hours for buprenorphine and methadone-exposed infants is the only definitive number. Other durations must be determined case by case.

Human Milk Safety Evaluation

Every decision regarding human milk administration must be carefully considered in a patient's unique context. Lactation consultation can ALWAYS be made available, regardless of specific substance exposure or any results of toxicology testing.

Safe Sleep

Review Safe Sleep 7 - every patient, every time.

Sober Caregiving

Consider gently offering examples of past use with non-judgemental follow-up questions about the challenge of adapting to a Safe & Sober Caregiver role: 

You used to take a gummy to go to sleep...

You used to drive after vaping THC...

...let's talk about a plan.

Warm Handoff to Social Work

Kim Pine and Sarah Tomlinson (or their colleagues) are anticipating your call! Reach out by Secure Chat or Epic VOIP.

Toxicology

Frequently not needed when universal screening and appropriate clinical interviewing has evaluated for substance use. MAY have clinical value and be indicated, but this should be explicitly documented along with consent.

Universal EI Referral

To be placed at discharge as outpatient order using fmcFAV. 

Nicotine

• Underappreciated impact on development, +/-withdrawal often manageable w/ routine care. 

• Ongoing exposure as newborn leads to increased hospitalizations in 1st year of life and asthma.

• Remember 2nd-hand exposure, which can also increase risk for sudden unexplained infant death, ear/nose/throat infections, upper respiratory infections, and allergies.

• Breastfeeding encouraged.

Alcohol

• Amount and timing that leads to FAS is unknown.

• Strategies for safe human milk administration are controversial. 🥩

Cannabis/THC/Marijuana

• Wide range given variation in forms, methods of consumptions, and amounts consumed. No specific impact on newborn length of stay, and requires careful counseling regarding human milk administration.

• NOT an absolute contraindication to breastfeeding. To facilitate advocacy, consider a Significant Event note with FMCOBTHC.

Psychiatric Medicines/Rx Stimulants

• Wide range of possible impacts, most often manageable within routine care.

• Consider Infant Risk Center consultation for guidance on human milk administration.

Opioids

• The ONLY indication for Eat, Sleep, Console - it is inapparopriate for any other substance exposure. Course differs depending on amount, context, and unique patient experiences with treatment. Extends newborn hospitalization.

• Breastfeeding likely encouraged, but in the setting of a personalized assessment.

Methamphetamine

• Plan be carefully considered based on the timing/context/amount of use.

• Breastfeeding and timing must be carefully considered and a unique safety plan made.

Other

• Many substance are not included in these categories. A unique plan for every patient is be required.